89 Hayden Rowe Street | Hopkinton | MA 01748 | Phone: 508-417-9360 | Fax: 508-497-9833
Commonly used employee forms appear below for your convenience. Many are screen-fillable. Please click on the form number to access the form. Please be aware that not all forms are applicable to all employees.

Please scroll down to view the complete list. If you have any questions, contact the Director of Human Resources for assistance.

LEAVE FORMS
HPS-L1
Request for Leave or Approved Absence
HPS-L2
Advanced Leave Agreement
HPS-L3
FMLA Employee Form (Non-HTA)
HPS-L4
FMLA Employee Form (HTA)
DOL-WH380E
FMLA Health Care Provider Form-Employee's Own Health Condition
DOL-WH380F
FMLA Health Care Provider Form-Family Member's Health Condition
DOL-WH384
FMLA Military Leave-Qualifying Exigency
DOL-WH385
FMLA Military Leave-Covered Service Member's Health Condition
BENEFIT FORMS
  Miscellaneous:
HPS-B1
Section 125 Cafeteria Plan Employee Waiver/Election & Compensation Reduction Agreement
DHCFR-EHIRD11
MA Health Insurance Responsibility Disclosure (HIRD) 2011
TOH-B1
Town of Hopkinton HIPAA Privacy Notice
TOH-B2
Town of Hopkinton HIPAA Privacy Acknowledgement
HPS-B3
Employee Assistance Program (EAP) Information
  Flexible Spending Accounts:
HPS-B3
Benefit Strategies Flex Spending Account Information
BENST-1
Benefit Strategies Flex Spending Account Reimbursement
BENST-3
Benefit Strategies Medical Flex Eligible Expenses
BENST-2
Benefit Strategies Flex Spending Account Enrollment '11-'12

Health Insurance (Medical):
TFT-1
Tufts Enrollment/Change Form (use for all Tufts products)
TFT-2
Tufts HMO Premium Summary of Benefits
TFT-3
Tufts Advantage HMO Summary of Benefits
TFT-HMO
Tufts Advantage & Premium HMO General Benefit Information
TFT-4
Tufts Carelink PPO Summary of Benefits
TFT-PPO
Tufts Carelink PPO General Benefit Information
TFT-5
Tufts Health Care Fitness Reimbursement Form
TFT-6
Tufts Pharmacy Review Request Form

Health Insurance (Dental):
DEL-1 Delta Dental Enrollment/Change Form
DEL-2 Delta Dental Premiere Voluntary Plan Information
DEL-3 Delta Dental Premiere Voluntary Enhanced Plan Information
ASRT-1 Assurant Dental Summary & Enrollment FY 12
  Long-Term Disability Insurance:
SL-1 Sun Life Long-Term Disability Enrollment Form
SL-2 Sun Life Long-Term Disability Claim Form
SL-3 Sun Life Long-Term Disability Evidence of Insurability Form
  Life Insurance:
BOS-A Boston Mutual Voluntary Life Information
BOS-1 Boston Mutual Life Evidence of Insurability Form
BOS-2 Boston Mutual Authorization for Release
BOS-3 Boston Mutual Life Enrollment/Declination Form
RETIREMENT PLAN FORMS
MCR-1 Middlesex County Retirement Board Enrollment Form
OBRA-1 OBRA (Mandatory Deferred Comp Plan) Information Sheet
OBRA-2 OBRA Acknowledgement Card
OBRA-3 OBRA Smart Plan Information Guide
TOH-B3 Town of Hopkinton Retiree Exit Form (to elect retiree health benefits)
CPI-0 403(b) Information Sheet
CPI-1 403(b) Elective Deferral & Vendor Election Form
CPI-2 Approved 403(b) Plan Vendor List
CPI-3 CPI Participant Website Instructions-403(b)
CPI-4 Request for a Contract Exchange-403(b)
CPI-5 Request for a Loan Voucher-403(b)
CPI-6 Request for a Hardship Withdrawl Voucher-403(b)
CPI-7 Request for a Distribution-403(b)
PROFESSIONAL DEVELOPMENT FORMS
HPS-PD1 Request for Conference Attendance
HP-PD Instructions Coursework Procedures Information Sheet
HPS-PD2 Intent to Submit
HPS-PD3 Course Approval
HPS-PD4 Tuition Reimbursement and/or Course Credit Request
HPS-PD5 Summer Curriculum Project Proposal
HPS-PD6 Inservice Course Credit Award Program Guidelines
HPS-PD7 Inservice Course Credit Approval
HPS-PD8 Inservice Course Certificate of Successful Completion
PERFORMANCE EVALUATION TEMPLATES
HPS-EVALSS/AA Evaluation Form - Secretarial Support/Administrative Assistants
HPS-EVALTA/SpEd Evaluation Form - Special Education Teaching Assistants
HPS-EVALTA/GenEd Evaluation Form - General Education Teaching Assistants
RECRUITING FORMS FOR ADMINISTRATORS
HPS-R1 Request for Approval to Begin Hire
HPS-R6 Interview Confidentiality Statement
HPS-CR Candidate Interview Rating Sheet-Numerical Score Format
HPS-CR1-LIK Candidate Interview Rating Sheet-Likert Scale Format
HPS-R2 Highly Qualified Teacher Checklist
HPS-R3 Highly Qualified Teacher Status Certificate
HPS-R4 Recommendation to Hire
HPS-R5 Release & Waiver of Confidentiality
HPS-REF1 Reference Check
MISCELLANEOUS NEW HIRE FORMS
FED-I9Y Employment Eligibility Verification (I-9)
SSA-1945 Statement Concerning Your Employment in a Job Not Covered by Social Security
SSA-0510045 Windfall Elimination Provision Fact Sheet
SSA-0510007 Government Pension Offset Fact Sheet
SSA-0510051 How State & Local Government Employees Are Covered by Social Security & Medicare
HPS-NH1 District Property Inventory
MA-EP Employment Permit Application for 14 through 17 year-olds
PAYROLL FORMS
MA-M4 MA Employee's Withholding Exemption Certificate (MA M-4)
FED-W4 Employee's Withholding Allowance Certificate (Federal W-4)
HPS-TA1 Non-Exempt & Contingent Employee's Time Sheet
HPS-P1 Direct Deposit Request
HPS-CURR Time Sheet for Curriculum Work Submission
MISCELLANEOUS FORMS
HPS-M1 Employee's Request for Reasonable Accommodation
HPS-EH Employee Handbook 2011-2012
HPS-EHA Employee Handbook Acknowledgement Form-Understanding by Employee
TOH-M1 Town of Hopkinton Hold Harmless for Volunteers
HPS-IR Incident Report
HPS-SIA Student Injury/Accident Report
HPS-EIR Employee Personal Injury Report
HPS-EX1 Mileage & Expenses Reimbursement Request (non-HTA)
MA-ETH Summary of the Conflict of Interest Law for Municipal Employees
SUBSTITUTE PACKET FOR ADMINISTRATORS
SUB-1 Substitute Teacher/Nurse Packet Instructions
SUB-2 Substitute Teacher Application
SUBN-2 Substitute Nurse Application
SUB-3 Substitute Interview Rating Form
SUB PAY Substitute Pay Rate Information
OBRA-1 OBRA (Mandatory Deferred Comp Plan) Information Sheet
OBRA-2 OBRA Acknowledgement Card
OBRA-3 OBRA Smart Plan Information Guide
SSA-1945 Statement Concerning Your Employment in a Job Not Covered by Social Security
FED-I9Y Employment Eligibility Verification (I-9)
FED-W4 Employee's Withholding Allowance Certificate (Federal W-4)
MA-M4 MA Employee's Withholding Exemption Certificate (MA M-4)
SUB-3 Substitute Teacher Job Description
HANDBK Substitute Handbook
HDBK-ACK Understanding by Substitute (Handbook Acknowledgement)
MA-ETH Summary of the Conflict of Interest Law for Municipal Employees
VOLUNTEER PACKET (for those volunteering in the schools)
CORI-SUB CORI Application for Volunteers
CON-INT Summary of Conflict of Interest Law
HOLD-HARMLESS Hold Harmless for Volunteers

 

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